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British clinicians share their experience with the management of airway stenosis in granulomatosis with polyangiitis. Treatment succeeds, but recurrence is common.
Martinez Del Pero M, Jayne D, Chaudhry A, et al. Long-term Outcome of Airway Stenosis in Granulomatosis With Polyangiitis (Wegener Granulomatosis) An Observational Study. JAMA Otolaryngol Head Neck Surg. (2014) Published online October 16, 2014. doi:10.1001/jamaoto.2014.2430
Most patients with granulomatosis with polyangiitis (GPA) who experience airway stenoses benefit from long periods of airway stability with treatment, but recurrence is common and requires lifelong follow-up, according to British head and neck specialists.
They offer one of the largest published series on airway management in GPA (previously known as Wegener granulomatosis), describing the epidemiology, treatments and outcomes at a British tertiary referral center. They also discuss their preferred algorithm to manage the condition.
At their institution, they saw 251 patients for GPA during a 15-year period, and nearly 20% had airway stenosis. The most common diagnoses were subglottic stenosis and lower airway stenosis.
The 39 patients who underwent balloon, bougie, or dilatation and laser interventions did require multiple procedures, but 97% achieved a prolonged period of airway patency.
However, recurrence of stenosis is independent of disease activity and the site of recurrence may change over time, the authors caution.